Interventions to reduce dependency in personal activities of daily living in community dwelling adults who use homecare services: a systematic review

Objectives: To identify interventions that aim to reduce dependency in activities of daily living (ADL) in homecare service users. To determine: content; effectiveness in improving ability to perform ADL; and whether delivery by qualified occupational therapists influences effectiveness. Data sources: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, OTseeker, PEDro, Web of Science, CIRRIE, and ASSIA. Review methods: We included: randomised controlled trials, non-randomised controlled trials and controlled before and after studies. Two reviewers independently screened studies for inclusion, assessed risk of bias and extracted data. A narrative synthesis of the findings was conducted. Results: Thirteen studies were included, totalling 4975 participants. Ten (77%) were judged to have risk of bias. Interventions were categorised as those termed ‘re-ablement’ or ‘restorative homecare’ (n=5/13); and those involving separate components which were not described using this terminology (n=8/13). Content of the intervention and level of health professional input varied within and between studies. Effectiveness on ADL: eight studies included an ADL outcome, five favoured the intervention group, only two with statistical significance, both these were controlled before and after studies judged at high risk of bias. ADL outcome was reported using seven different measures. Occupational therapy: there was insufficient evidence to determine whether involvement of qualified occupational therapists influenced effectiveness. Conclusion: There is limited evidence that interventions targeted at personal ADL can reduce homecare service users’ dependency with activities, the content of evaluated interventions varies greatly

A systematic review of the evidence on home care reablement services

Objective To determine whether publically funded ‘reablement services’ have any effect on patient health or use of services. Design Systematic review of randomised controlled trials and non-randomized studies in which reablement interventions were compared to no care or usual care in people referred to public funded personal care services. Data sources included: Cochrane central register of controlled trials, EPOC register of studies, trials registers, Medline, Embase, and Cinhal. Searches were from 2000 up to end February 2015. Setting Not applicable. Participants Investigators’ definition of the target population for reablement interventions. Main outcome measures Use of publically-funded personal care services and dependence in personal activities of daily living (PADL). Results We found no studies fulfilling our inclusion criteria that assessed the effectiveness of reablement interventions. We did note the lack of an agreed understanding of the nature of reablement. Conclusions Reablement is an ill-defined intervention targeted towards an ill-defined and potentially highly heterogeneous population/ patient group. There is no evidence to suggest it is effective at either of its goals, increasing personal independence or reducing use of personal care services

Occupational therapy in HomEcare Re-ablement Services (OTHERS): study protocol for a randomized controlled trial

Background: Homecare re-ablement services have been developed by local authorities in England in response to the government agenda for health and social care. These services aim to optimize users’ independence and ability to cope at home, and reduce the need for ongoing health and social care services. However, there is currently limited evidence and guidance regarding the optimum configuration and delivery of re-ablement services. In particular, the impact of occupational therapy input on service user outcomes has been highlighted as a specific research priority. Methods/Design: This feasibility randomized controlled trial (RCT) will recruit 50 people from one local authority led homecare re-ablement service in England. Those who provide informed consent will be randomized to receive either usual homecare re-ablement (without routine occupational therapy input) or usual homecare re-ablement plus an enhanced program targeted at activities of daily living (ADL), delivered by an occupational therapist. The primary aim of this study is to assess the feasibility of conducting a further, powered study. The participant outcomes assessed will be independence in personal and extended ADL, health and social care-related quality of life, number of care support hours, falls, acute and residential admissions and use of health and social care services. These will be assessed at two weeks, three months and six months post-discharge from the re-ablement service. Discussion: To our knowledge, this is the first RCT of occupational therapy in homecare re-ablement services. The results of this study will lay the foundations for a further powered study. The findings will be relevant to researchers, clinicians, commissioners and users of adult social care services

OVERLAPPED CLUSTERING APPROACH FOR MAXIMIZING THE SERVICE RELIABILITY OF HETEROGENEOUS DISTRIBUTED COMPUTING SYSTEMS

ABSTRACT For distributed computing system (DCS) where server nodes can fail permanently with nonzero probability, the reliability of the system can be defined as the probability that the system run the entire tasks successfully assign on it before all the nodes fail. In heterogeneous distributed system where various nodes of the system have different characteristics, reliability of the system is highly dependent on the tasks allocation strategies. So, this paper presents a rigorous framework for efficient tasks allocation in heterogeneous distributed environment, with the goal of maximizing the system reliability. Reliability of the system is characterized in the presence of communication uncertainties and topological changes due to node's failure. Node failure has adverse effects on the system reliability. Thus, one possible way to improve reliability is to make the communication among the tasks as local as possible. For this, an overlapped clustering approach has been used. Further, we calculate the reliability of each node of the DCS to determine the actual capabilities of each node. Here, our purpose is to assign the more costly task to more reliable node of the DCS. Then we utilize the load balancing policies for handling the node's failure effect as well as maximizing the service reliability of the DCS. A numeric example is presented to illustrate the importance of incorporating overlapping cluster and load balancing on the reliability study

2017 American Family Survey

In July of 2017, the Deseret News and The Center for the Study of Elections and Democracy at Brigham Young University fielded a survey on the family in America. This survey was administered by YouGov to a sample of 3,000 adult respondents whose characteristics mirror those of the general population. Each version of the American Family Survey has different in-depth module. The 2017 AFS explores government supporting families and family experience across several issues including addiction, technology, and healthcare

An examination of factors influencing delayed discharge of older people from hospital

Objective This study aimed to investigate the factors associated with the delayed discharge of older people from hospital and their length of stay (LOS). Methods Data were collected retrospectively from inpatient records and adult social care services on older patients referred to the latter prior to hospital discharge. Results Data on two related measures - delayed discharge and LOS - were analysed separately within a four-stage sequential framework. Using bivariate analysis, we found that cognitive impairment and dependency were significantly associated with delay. Patients admitted to trauma and orthopaedics specialties were significantly more likely to be delayed on discharge. Respiratory illness was negatively associated with delay. Factors related to care received as an inpatient associated with delayed discharge from hospital were not being in the responsible consultant's bed for part of their stay, two or more moves between specialties and receipt of rehabilitation services. Admission to a care home and receipt of domiciliary care if returning to a private dwelling on discharge were associated with delay. In the multivariate analysis, dependence and cognitive impairment impacted differently on delay and LOS. Hospital variables were the most important predictors of LOS and social care variables in respect of delayed discharge. Conclusion Patient characteristics and especially the organisation of care in hospital and the provision of services on discharge are related to the likelihood of delayed discharge and LOS. Improved services and structures to systematically assess and treat patient needs in hospital, together with the timely provision of services providing post-discharge services tailored to individual circumstances, are required. Copyright © 2013 John Wiley & Sons, Ltd